Ohio University
Psychology and Social Work Clinic
Please click or tap the appropriate menu item below to indicate the forms you wish to complete.
1. Initial Contact Form
2. Emergency Crisis Resources
3. Before My Counseling Session
4. After My Counseling Session
5. Adult Therapy Consent Process
6. Child Therapy Consent Process
7. Coping Crew/BEAST Consent Process
8. Scar, Beast & Clue Consent Process
9. MDQ
10. HTC Consultation Consents
11. Adult Assessment Consent Process
12. Child Assessment Consent Process
13. Adult THERAPY Intake Form
14. Child THERAPY Intake Form
15. Adult ASSESSMENT Intake Form
16. Telepsychology Consent Form
17. TeleAssessment Consent Form
18. Group Therapy Consent
19a. Financial Agreement for Psychotherapy
19b. Financial Agreement for Psychological/Neuropsychological Evaluation
19c. Consent to Bill Ohio University Student Account
20. Consent to Bill the Student Information System
21. Coping Crew/BEAST/SCAR Financial Consent
23. Disclosure Form
24. Consent for Research
25. Consent to Record/Observe
26. Digital Communication Policy & Consent
27. Email Reminders Consent Form
28. Privacy Practices Notice
29. Receipt of Privacy Practices Notice
30. Authorization to Request/Disclose Patient Protected Health Information
32. Authorization to Request Educational Records
33. Adult Preliminary Treatment Plan: Triage/Intake
34. Child/Family Preliminary Treatment Plan: Intake
35. PHQ - 9
36. GAD - 7
37. PSWQ
38. AUDIT
39. DUDIT
40. PCL - 5
41. MSI-BPD
42. PHQ - Adolescent
43. CES-DC
44. SCARED - PARENT Version
45. SCARED - CHILD Version
46. BAARS-IV: Self-Report: Childhood Symptoms
47. BDEFS-LF: Self-Report
48. BFIS-LF: Self-Report
49. IRS - Parent Report
50. IRS - Teacher Report
51. SDQ - Parent Report for children ages 4-10
52. SDQ Follow-Up - Parent Report for children ages 4-10
53. SDQ - Parent Report for childre/adolescents ages 11-17
54. SDQ Follow-Up - Parent Report for children/adolescents ages 11-17
55. DBD - Parent/Teacher
56. SDQ - Teacher Report Measures for Childern and Adolescents (T)04-10
57. SDQ - Teacher Report Measures for Children and Adolescents (T) 11-17
58. SDQ - Youth Self-report
59. SDQ Follow-Up - Youth Self-report
60. CEQ
61. Group/Interventions Contact Form
62. IPQ
63. ISI
64. FoSI-SF
65. EAC Adult Intake Part 3
66. Group Therapy Consent Process - HTC Student
67. Therapy Consent (in person sessions)
68. HTC Consents for Ongoing Therapy After Consultation
69. Brief Biosocial Gambling Screen